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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on February 22, 2005, at 17:50:32
In reply to Why I Hate Neuroleptics and Forced Hosptialization, posted by med_empowered on February 22, 2005, at 15:59:32
What is schizophrenia?
What causes schizophrenia?
- Scott
Posted by med_empowered on February 22, 2005, at 17:51:42
In reply to Re: Why I Hate Neuroleptics and Forced Hosptialization, posted by banga on February 22, 2005, at 16:47:43
Lots of drugs have been used as models for schizophrenia. The first two were mescaline and LSD...for a while, some psychiatrists even used hallucinogenic agents themselves so they could experience "first-hand" what their patients were going through. THe government also funded many studies using these agents, some of which were highly unethical. The LSD/mescaline model was abandoned for a number of reasons (for one thing, the variability of the drug experience; for another, hallucinogens seem to induce visuals-heavy hallucinations, while schizophrenia is more often characterized by audio hallucinations). Other drug models have been used, as well...amphetamines, Ritalin, ketamine, and (I believe) PCP. Problems with drug models include: there doesn't appear to be any condition in animals that can be reliably compared to schizophrenia in humans. From what scientists have been able to piece together, it appears schizophrenia is a uniquely human experience. Also, the research itself has yielded little insight into treatment or diagnosis. The closest the research came to doing that was the amphetamine/Ritalin research, which suggested that since these drugs can induce or worsen psychosis through an effect on dopamine, schizophrenia may be a dopamine disorder. Since scientists at the time had just figured out that neuroleptics work on dopamine, it looked like they had found a winner. They hadn't. Anyone can have a stimulant-induced psychotic episode...though some people ARE more sensitive to this psychosis than others, it doesn't seem that this sensitivty is related to any underlying mental illness, although people who have been treated with neuroleptics are theoretically more sensitive than most others because of changes in the brain caused by neuroleptics. Also, I always try to remember to look at the study itself...many of the drug-model studies were funded by the NIMH, and continued until 1998. Around that time, there were lawsuits from patients who were claimed they were experimented on without their consent. There were also (and should be) serious ethical concerns about using those in the throes of psychosis in experiments. Those who favored the research said that even the floridly psychotic had the needed competence to agreee to such research (awfully convenient!), even though many of the subjects were INVOLUNTARILY HOSPITALIZED. Basically, these studies were often done on patients that were accessible...this raises serious problems, because the sample sucks (not even close to random) and adequate controls for other variables (drug exposure, gender, age, income, race, length of time with illness) were not in place.
Posted by Phillipa on February 22, 2005, at 18:58:01
In reply to Re: Why I Hate Neuroleptics and Forced Hosptialization » med_empowered, posted by SLS on February 22, 2005, at 17:50:32
US News, February 28th edition, states that schizophrenics have an altered sense of smell. They don't elaborate on that. Fondly, Phillipa
Posted by linkadge on February 22, 2005, at 19:24:42
In reply to Drug models of schizophrenia, posted by med_empowered on February 22, 2005, at 17:51:42
Nobody said we had clear cut evidence as to the nature of anything. Infact, anything can be debatable.Here is some truth. The theraputic actions of these drugs were often realized before any purported mechanisms were put into place.
For instance, the actions of the MAOI's were noted far before anyone ever knew what MAO was.
I guess what I am getting at is this. What gives?
What does it matter if we know how these drugs work. It is more about ethics.Sure the drugs aren't reliable all the time. But neither is anything else we have. If we had something that worked better, then we would use it.
Every time I get paranoid about the whole concept of mentall illness (how some propose that it is invented by the drug compaines) I remember our little friend Lithium.
Not only is it effective for bipolar disorder, and some forms of schisophrenia, and depression,
it is not a money maker for "anyone". Does it matter that we don't know the actions of lithium.Of course it doesn't. What matters is that it is robustly neuroprotective, neurotrophic, increases grey matter, antisuicide effect, reducing rehospitalizaction bla bla bla.
It comes down to this. People are suffering. We know that some of these agents (perhaps not all) do have some ability to relieve human suffering. Isn't that enough incentive to continue their use.
It only takes a sane brain a few minautes in conversation with a schitsohrenic to know that they have problems.
------------------------------------------
"No study has been able to pinpoint reliable, consistent differences between the brains of "normals" and "sick" individuals"
------------------------------------------Well I guess we havn't been able to "pinpoint" why aspirin relieves certain pain. Should we stop using it alltogether. Its a world of speculation, and in the midst of such profound and immanent suffering, can we afford not to act on certain speculations?
If we believe that these people are geniune in their illness (ie they're not pretending), if it wasn't the brain that mediated this behavior, what mediates it?
Anyone can raise a flag. I at least admire the effort of these scientist to make real and tangable changes in the lives of people who are suffering.
Have you seen the movie, A beautiful Mind? If this was not a "mental illness" what do you propose was at the heart of this man's suffering?
If haldol helps, when vigourous exercise, proper nutrition, and adequate social contact fails, what does it matter?Linkadge
Posted by linkadge on February 22, 2005, at 19:36:49
In reply to Re: Drug models of schizophrenia, posted by linkadge on February 22, 2005, at 19:24:42
One study found exceedinly more biproducts of phenylalanine, and anandamide in the brains of schitsohrenics. Anandamide is a naturally occuring brain compound with anticholinergic, and delieriant effects in high doses. Its action is mimicked by some of the halucinogenic compounds in marajuana, chocolate, and excssive exercise.
Phenylalanine can also produce paranoia, and delerium in human subjects at ultra-physiological doses.
Posted by med_empowered on February 22, 2005, at 19:46:41
In reply to Re: Drug models of schizophrenia, posted by linkadge on February 22, 2005, at 19:24:42
I don't know what the motives of those constantly searching for the biological basis of schizophrenia are. Really, for me its a non-issue. In scientific endeavors, even in sociology, which is my future field, all research is subject to review...a harsh, scathing, rip-it-apart review. This isn't done to be mean or destroy data, its done for the good of the whole pursuit...it helps move closer towards understanding. The biological basis of schizophrenia or any other mental illness isn't proven, yet we are told that "it must be biological"...this ignores other perspectives that could yield some insight. Take the Soteria Project, which in the 70's provided a non-drug environment in which people with schizophrenia could come to live and connect with a few other people with schizophrenia, and a mostly non-professional staff. The results were great, and the data is solid (it was started by Loren Mosher, who was the first head of NIMH), and some European countries are using the concept now, and there may be an Alaskan Soteria House soon. But...no one pursues it here. THe biological perspective is the "accepted" understanding of schizophrenia and mental illness. When we ignore other perspectives in something as serious as schizophrenia, and ignore the shortcomings of available data, we do science and the mentally ill, and society as a whole a great dis-service. I personally think along more or less the same lines as Thomas Szasz, who concluded that a diagnosis of any mental illness is really a "moral judgement". Maybe calling someone who is acting and thinking oddly "schizophrenic" is a relatively humane option, but are there others? Could we spend some of the money we spend on forced treatment on, say, helping the poor and minorities? (the poor and minorities are overrepresented in the schizophrenic group, and have been since the disease was "discovered"). Could we try some non-biological therapies, and see how that goes? I'm not saying we won't one day find that schizophrenia has some of its roots in biology, but I AM saying that the current "broken-brain" orthodoxy is seriously damaging to any kind of inquiry that seeks an alternative way to help individuals. I'm also afraid that telling troubled people that they are "sick" excuses society. Yes, mental illness responds to treatments that address the brain, but does this mean that ignoring possible social factors is good science, or even ethical? Isn't it concerning, also, that people who display abnormal behaviors are cast off as suffering from "a brain disease"? It lets everyone ignore them and what they're going through, and it denies us all an oppurtunity to learn.
Posted by linkadge on February 22, 2005, at 20:03:33
In reply to OK, I guess this is my point..., posted by med_empowered on February 22, 2005, at 19:46:41
Hey, I'm all for non-biological alternatives. The medications are just one tool in the box. They are by no means the only tool.
There are many factors that may interact, genes, environment, stress etc. Tackling any aspect could improve the lives of those involved.
But on the other hand, the medications do have a place. Just as not everyone responds to drugs, some cases only respond to drugs.
If understanding the drugs mechanisms helps us develop more effective drugs with less drastic long term side effects, then all for it.
But you are certainly right in that it is really pointless, (and dangerous) for us to force ourself to believe that the disease has only one root.
Linkadge
Posted by banga on February 22, 2005, at 20:23:22
In reply to OK, I guess this is my point..., posted by med_empowered on February 22, 2005, at 19:46:41
I don't know...I at least have understood for a long time that in many ailments including schizophrenia, both biological and psychosocial elements play a role. In recent twins studies it has been noted that in twins discordant for schizophrenia (one twin has it, the other doesn't), the one who doesnt is found to nevertheless have some underlying deficits--hinting that perhaps (of course this is theory)she/he has the biological vulnerability but wasn't triggered by environmental factors.
It is certainly not that you don't have some good points, but I am not sure who your audience is.....in psychology I think it is quite accepted that mental health issues often involve BOTH bio and environmental factors....and just because someone believes biology plays a role and meds can be helpful doesņ't mean they think other nonmed treatments aren't helpful and legitimate, and say "the more power to you!" if you do find a nonmed treatment that works well.
Though I am sure that some pdocs think tons of meds alone is the full answer, I think very many pay attention to data that show a combo of psychosocial intervention along with meds for any illness is the best recipe. I see plenty of studies looking at how people with schizophrenia can be helped with other, nonmed interventions, with great results.
I am not sure why you frame it as if it has to be one or the other.....A good parallel (perhaps overused) could be very high blood pressure--you have a predispotition, which has a greater chance of emerging if you expose yourself to external conditions (stress, diet, exersise or lack thereof)... some people may find ways to control it without meds, but many find that in addition to better lifestyle they do need a little medication to keep it under control.
I suffered ten years before I agreed to take antidepressants. Yes they are far, far from perfect; I agree that people should be more careful with wording--that the neurotransmitter deficiency theories for now are theories, not facts. They should label much better RE risks and withdrawal effects. But these meds are what we have got. It would be unethical for doctors to deny suffering patients these medications because we haven't proven *why* they work. And unethical to give them to a patient who lacks the judgement to see she/he is doing worse without them and is a danger to themselves.
Having said all that, I am of course VERY concerned about the instances where patient/subject rights are not protected, where people are overmedicated, etc. I am sure especially years past patients were mistreated and used like guinea pigs. Less so these days.
I believe that meds can be very helpful AND I believe we actually know little about them. I do also believe they are powerful and misuse of them can be harmful.Anyways I am gabbing on a bit here...
Posted by gardenergirl on February 22, 2005, at 20:44:43
In reply to OK, I guess this is my point..., posted by med_empowered on February 22, 2005, at 19:46:41
I'm really lost here. I've never heard that schizophrenia is entirely a biological disorder. Like every diagnosis of mental disorders I can think of, there has been evidence that shows correlations to biological factors and to environmental factors. It's all nature/nurture.
So, some scientists are exploring nature. Some nurture. I seriously doubt that there will ever be ONE answer in my lifetime. We're far too complex beings.
And I'm not following how the "cause" of schizophrenia relates to involuntary hospitalization. From my work and educational experience, a person must be a danger to themselves or others to be non-vol'd. Doesn't matter what their diagnosis is or how they "got" it, it's the symptoms, behavior, and support system (or lack of) that are the determinants. Being a danger to oneself includes not being able to take care of oneself.
Even if we were able to determine that schizophrenia, for example, is entirely nurture, that doesn't mean that biological treatments might not be affective in treating the symptoms. And it doesn't mean that someone might not be a danger to themself.
gg
Posted by banga on February 22, 2005, at 20:52:35
In reply to Re: OK, I guess this is my point..., posted by gardenergirl on February 22, 2005, at 20:44:43
Yes, exactly....What I said in 3000 words, both linkadge and gardenergirl said in 30 so well!
Posted by med_empowered on February 22, 2005, at 21:51:20
In reply to Re: OK, I guess this is my point..., posted by linkadge on February 22, 2005, at 20:03:33
hey, yet again! The reason I posted this whole thing, which I REALLY DID NOT MEAN TO CAUSE TOO MUCH CONTROVERSY was that the more I researched this paper, the more flaws I found with the "broken brain" concept. Oh, before my next big message-- LOTS of states (in the late 90s about 41) have changed their commitment laws. Commitment laws went from kind of lax to much more stringent following: deinstitutionalization and the psychiatric survivor's movement. Most states only allowed for hospitalization if the person involved was considered a threat to himself and/or others, or if the illness in question was so severe that the patient could not even work towards his/her own basic survival. This was a pretty big standard, and 19 states also allowed the person in question to request a trial BY JURY. Now, the standards have changed. If a patient is at high risk of "relapse" or "deterioration," he/she might be committed. In addition, patients who are NOT considered a risk to themselves or others can be compelled to take medication under the threat of hospitalization/re-hospitalization. The old laws weren't great, mind you, but they at least provided some protections...the new laws treat hospitalization much more lightly. When you take into consideration the fact that this "therapeutic intervention" involves depriving people of their freedom and/or forcing them into "treatment" (in fields of medicine besides psychiatry, patients have the right to refuse treatment..even if they may die or suffer serious harm as a result), this becomes a huge issue: these states are basically giving the mentally ill fewer civil rights than everyone else. I know hospitalization is supposed to "help," and that the shrinks involved are trying to "assist" the patient, but it's like the old saying goes: the road to hell is paved with good intentions. Whatever the intent, the result is that many states can now forcibly hospitalize far more patients than before, which not only negatively impacts the shrink/patient power-balance, but also the society/individual power-balance as well.
Posted by med_empowered on February 22, 2005, at 22:13:47
In reply to Re: OK, I guess this is my point..., posted by banga on February 22, 2005, at 20:52:35
Here's the deal: my paper/ pet project on mental illness led me to the conclusion that the biological perspective in terms of mental illness is pretty flawed. Inquiry into alternative perspectives and treatments has been seriously hampered. This is not just bad science, this is flat-out misleading and deceptive. We do not KNOW that mental illness is a "brain disorder," though it is a popular theory. We do know that chemical/biological treatments are often effective...but to connect the two would be inappropriate. Science isn't supposed to be dogmatic; the idea is that scientific inquiry should be used to explore issues/problems and that no one explanation should be valued more than another without very strong, very compelling data. In terms of mental illness, especially schizophrenia, the US psychiatric establishment has focused single-mindedly on the "broken brain" concept. Take, for instance, the international studies on schizophrenia...there are 2 BIG ones. The first showed that patients in the United States and other western, developed countries have a tendency to become chronically ill, even with medical treatment. Poorer countries, in Africa, Asia, etc. had better results in terms out long-term outcome, despite a low (16%) level of regular medication use. The follow-up showed pretty much the same thing. Psychiatrists have tended to dismiss the study, but the data was incredibly high-quality and consistent; furthermore, the studies were done by the World Health Organization...the same Org. that has helped in massive vaccination efforts, helped fight the war on AIDS, etc. There wasn't a political motive--it was simply scientific inquiry that produced results those dogmatically attached to one explanation didn't like. The studies continue to be ignored. This is a HUGE issue...in 1994, Harvard researchers released a study in which they concluded that the outcome for schizophrenic patients was essentially unchanged since the 1800's. Schizophrenics continue to have incredibly high suicide rates (around 15%) and other problems. So, to sum all this up, I didn't start this "discussion" to say that genetics don't play a role, or that genes don't play a role, but instead to emphasize that maybe society has a role, a big role, in the entire concept of mental health. While we're looking at brain scans and investigating drugs, we also need to look at very basic questions that I simply don't think have been adequately addressed. HOW do we define mental illness? Why does this seem to change over time? WHO are the mentally ill? Why does it seem that an unusual number of them are women, minorities, and/or poor? Why do mentally ill do better in some situations and/or societies than others? How do we define "improvement," anyway?
Posted by Phillipa on February 22, 2005, at 23:22:51
In reply to And I guess this is why I posted..., posted by med_empowered on February 22, 2005, at 22:13:47
The ability to function according to Society's expectations. Of course, that means what society, it could be a simple society as in lets say a remote Island setting. Or a complicated setting such as a big City like New York. More stresses, more crime, more expectations, more money required to survive, it goes on and on. Again, I say let's form Babbleland. All these minds and knowledge. You stand in front of them and state your problems and all the experts put their minds together and come up with a plan. Alternative as well as medical. Now that would be a place I would want to be. I'm tired so I guess I'm really Babbling. Fondly, Phillipa
Posted by linkadge on February 22, 2005, at 23:28:01
In reply to And I guess this is why I posted..., posted by med_empowered on February 22, 2005, at 22:13:47
------------------------------------------------
We do not KNOW that mental illness is a "brain disorder,"
------------------------------------------------
Few!!! I was beginning to think that mental illness was a disorder of the large intestine!
Linakdge
Posted by linkadge on February 22, 2005, at 23:33:15
In reply to Re: And I guess this is why I posted..., posted by linkadge on February 22, 2005, at 23:28:01
------------------------------------------------
We do not KNOW that mental illness is a "brain disorder,"
------------------------------------------------Are you another propotent, of the mental illness is a disorder of the large intestine theory ??
Linkadge
Posted by linkadge on February 22, 2005, at 23:42:47
In reply to ******What I meant to say.....***, posted by linkadge on February 22, 2005, at 23:33:15
It doesn't make any sence to me. With a name like "med-empowered" it seems like you must be taking medications for some type of mental illness. Which means that you are buying into the idea that mentall illness *is* a brain disorder.
To turn that around and say that another mental illness is factitious, made up, and not a brain disorder doesn't make any sence to me.
I mean if you want proof, stop taking your meds long enought to give yourself a refresher on why mental illness *may infact* be a brain disorder.
Linkadge
Posted by Mistermindmasta on February 23, 2005, at 0:02:14
In reply to Re: Why I Hate Neuroleptics and Forced Hosptialization, posted by med_empowered on February 22, 2005, at 16:46:17
"The problems with these and other "findings" (such as reduced volume of the thalamus, etc.) include: 1) although some studies have identified brain "abnormalities" that are more common in the schizophrenic group than the non-schizophrenic group, these "abnormalities" tend to be observed in BOTH GROUPS. They also are not found in ALL, and, often, not even in MOST schizophrenics. The difference between the two groups, then, is one of frequency of the observed abnormality."
So you are saying that certain abnormalities are more frequent among schizophrenics? I wouldn't say this is a sure sign that the disease is biological in origin, but it definitely adds to the data to support the idea.
"Compare this to...brain cancer. THose who have brain cancer can be diagnosed with a brain scan showing the presence of tumor. Those without brain cancer don't have such tumors. The physical differences between the two groups is such that they establish a diagnostic test, and the differences are pretty simple: present or not present, therefore the patient is sick or not sick."
I don't think that's a good analogy. It's ok, but not good. If, for example, seeing underactive NMDA glutamate pathways were as easy as seeing tumors, then yes, I would say it's a good analogy.
Posted by SLS on February 23, 2005, at 7:33:52
In reply to Why I Hate Neuroleptics and Forced Hosptialization, posted by med_empowered on February 22, 2005, at 15:59:32
I have a great deal of trouble reading. If you have already answered these questions, perhaps you can just post the link for it here:
Thanks.
- Scott
Posted by gardenergirl on February 23, 2005, at 11:40:53
In reply to About Hospitalization.., posted by med_empowered on February 22, 2005, at 21:51:20
Just to clarify, anyone who is forced to take meds is "forced" by the courts. That means they are either deemed not competent to make this decision for themself or there is some other compelling reason, i.e. trying to avoid prosecution by remaining impaired, that the courts make this decision. It's not just because any one person thinks it's best.
And determining competency to make this decision (about meds) is done by professionally trained evaluators.
gg
Posted by willyee on February 24, 2005, at 22:29:11
In reply to Why I Hate Neuroleptics and Forced Hosptialization, posted by med_empowered on February 22, 2005, at 15:59:32
I began reading this and then looked at how long the thread goes,im wondering if the writer or anyone can tell me is he aganist medication period,or forced upon schzo patients?
I see he wrote there is no proof of any chemical imbalances that are consistent.
Well i read and have saved tons of studies done at universaties where serum fluids of depressed-non depressed are matched,and they are almost always notable differences,the only misleading thing is to say there is one,there is a LOT.
The ratio of excitaory amninos in genral,to inhibitory ones in depressed brains are almost always off,certain ones tend to show and abundance,and there is more activity,electrical current in certain areas of the brains,as if certain parts are heating up.
I believe for certain true clinical emotional disorders,albeit anxiety,depression,etc are a pyshical disruption of some sort,absolutly,and its tiring to see people who dont not suffer from it respond the same,if u dont suffer from it then of course it would seem easy to overcome it with all the crap that is laid on the table,all the techniques,thinking strategies etc.
I believe we dont know what is the cause or a have a clear definatition,and its likly the things we can see the imbalances for example might be the end result of whats happening.
But to disregard the theory that its a pyhsical disease,has as little proof as proving otherwise.
We simply dont know,unfortunatly for us.
And professional evalutoion,im sick of hearing leave it to the professionals too,unless your a nurologist who is taking eeg scans of my brain,or an mri,or the like,then you are in no better situation than i,which is to search for documentation,they use a PDR,i use google,but hardly any thing scientififc goes on inside a p-docs office while prescriping.
Posted by ed_uk on February 26, 2005, at 16:13:11
In reply to Re: Why I Hate Neuroleptics and Forced Hosptialization, posted by willyee on February 24, 2005, at 22:29:11
Where are you med? I was enjoying reading your views. I think certain people misunderstood your posts which is why they were harsh. Come back to p-babble!!
Ed.
Posted by banga on February 26, 2005, at 17:18:16
In reply to Re: Where is med_empowered?, posted by ed_uk on February 26, 2005, at 16:13:11
I was wondering where you have gone too--you are missed...I apololgize if my posts seemed argumentative, that is definietly not what I intended. I agreed with you on many points, especially about other countries/cultures perhaps having a more healthy attitude towards those who have difficulties--maybe I didn't stress that enough.
Posted by Phillipa on February 26, 2005, at 17:37:35
In reply to Re: Where is med_empowered?, posted by banga on February 26, 2005, at 17:18:16
Please come back med_empowered. We miss you, and the great Posts. Fondly, Phillipa
Posted by yxibow on February 27, 2005, at 17:00:44
In reply to Re: Why I Hate Neuroleptics and Forced Hosptialization, posted by willyee on February 24, 2005, at 22:29:11
> And professional evalutoion,im sick of hearing leave it to the professionals too,unless your a nurologist who is taking eeg scans of my brain,or an mri,or the like,then you are in no better situation than i,which is to search for documentation,they use a PDR,i use google,but hardly any thing scientififc goes on inside a p-docs office while prescriping.
Without leading to great argument; there is definately more that goes inside a psychiatrist's office, especially a psychopharmacologist's office. Granted every doctor's competency varies, but they've been trained to the intricacies of such things as the P450 system, to prevent giving you two medications that would play havoc with your liver, and have gone to medical school a few years more than the average patient who walks in their office.Now, I'm not saying informed consent isn't a good thing, I research just as much as I can see anyone else here does, and that's a good thing... there's nothing wrong with a balance of self-knowledge and doctor-mediated discovery. Of course if you read too much, you could get medical-student syndrome (the "I have everything in the book" disorder).
As for the field of neurology, EEGs, MRIs, PET scans are tools that can differentiate psychiatric biochemical imbalance diagnoses from those that are organic brain disorders like epilepsy; but PET scans are only so good at this point, they're not going to tell you what medication one should try f or a particular biochemical disorder. I only wish they were.
The level of visual discovery has not reached the neuronal point; so we rely on the hopefully good competency of a psychopharmacologist who can tease out the complexity of a disorder a patient may have, and through personal wisdom, continuing education, and peer review, attempt to help and provide advice at a level that we have reached in 2005.
May the future 50 years hold brighter days than the remarkable progress that the past 50 have, which began with the introduction of the first antidepressants, iproniazid, and imipramine.
Posted by Phillipa on February 27, 2005, at 17:20:34
In reply to Re: Why I Hate Neuroleptics and Forced Hosptializa, posted by yxibow on February 27, 2005, at 17:00:44
Someone Posted that psychopharmacologists have no more training than any other pdoc. Is this true? Fondly,Phillipa
This is the end of the thread.
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